Psoriasis Vulgaris
Conditions
Keywords
Therapeutic drug monitoring, Psoriasis, Adalimumab
Brief summary
The optimal therapeutic serum trough level (Ctrough) of adalimumab was defined between 3,5 and 7,0 µg/ml in patients with plaque type psoriasis. An adalimumab Ctrough above this therapeutic range did not add clinical response. Based on this therapeutic window, the introduction of dose adjustments based on Ctroughs (therapeutic drug monitoring) will be further validated in a prospective randomized-controlled trial. Here, we aim to determine whether, in patients with a good clinical response and supratherapeutic adalimumab Ctroughs, dose reduction is able to maintain favorable clinical outcome.
Detailed description
Patients will be included after signing informed consent and randomized in either a standard dose arm or a concentration based arm based on prior Ctrough measurements. In the concentration based arm, dosing frequency will be lowered to once every 3 weeks. If patients still have supratherapeutic Ctroughs of adalimumab, these patients will continue adalimumab self-administration every 4 weeks. In the standard based arm, patients will continue on standard dosing schedule. During each study visit blood will be taken in order to quantify Ctroughs. In addition, Psoriasis Area and Severity Index (PASI) and Investigator's Global Assessment (IGA) score will be evaluated by a physician. Patients complete the Dermatology Life Quality Index (DLQI) and European quality of life EQ-5D instrument at each visit. In addition, in a subset of patients in each treatment arm, additional sampling will be collected by dried blood spot sampling in order to build a PK(PD) model for adalimumab.
Interventions
PROCEDUREVenapuncture
Blood samples will be collected to determine the serum trough levels and anti-drug antibodies of adalimumab.
PROCEDUREDried blood spot
A subset of patients will sample additionally by using the dried blood sampling technique.
DRUGDose reduction
Adalimumab dosing frequency will be lowered in patients who have supratherapeutic serum trough levels of adalimumab.
Sponsors
KU Leuven
University Ghent
University Hospital, Ghent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
A randomized non-inferiority study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Participants must have a clinical or histological diagnosis of chronic plaque-type psoriasis for at least 6 months prior to inclusion 2. Participants must have a stable disease during maintenance on adalimumab (absolute PASI \< 3) 3. Participants are not allowed to use topical steroids from 7 days before randomization until the end of the study (week 48). 4. Participants must sign an ICF indicating that he or she understands the purpose of, and procedures required for, the study and is willing to participate in the study
Exclusion criteria
1. Participants who have currently a predominant nonplaque form of psoriasis 2. Participants who are pregnant, nursing or planning a pregnancy while enrolled in the study or within 12 weeks after receiving the last administration of study intervention 3. Participants who are unable or unwilling to undergo multiple venapunctures 4. Participants who are treated according to a different dosing schedule than standard dosing of adalimumab (regular dose regimen every 2 weeks; 40 mg)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical response | Week 0- Week 48 | The proportion of patients in each group in clinical remission (absolute PASI \< 2) at year 1 after optimization |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The proportion of patients in each group with serum trough levels of adalimumab within the optimal interval. | Week 0- Week 48 | — |
| The proportion of patients in each group with anti-drug antibodies (ADA) against adalimumab. | Week 0- Week 48 | — |
| Relapse | Week 0- Week 48 | The proportion of patients in each group who relapses (defined as the need for dose escalation (not in the standard based dosing arm)) |
Countries
Belgium
Outcome results
None listed